The microfoundations of institutional theory and discourse of professionalism: The case of physicians, medical scribes, and electronic health records

Bryan, Ann L

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https://hdl.handle.net/2142/115540 Copy

Description

Title

The microfoundations of institutional theory and discourse of professionalism: The case of physicians, medical scribes, and electronic health records

Author(s)

Bryan, Ann L

Issue Date

2022-04-14

Director of Research (if dissertation) or Advisor (if thesis)

Lammers, John C

Doctoral Committee Chair(s)

Lammers, John C

Committee Member(s)

• Poole, Marshall Scott
• Jackson, Sally A
• Barley, William C

Department of Study

Communication

Discipline

Communication

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Electronic health records
• physicians
• medical scribes
• institutional theory
• discourse of professionalism
• profession

Abstract

This dissertation draws together literature on institutional theory, practice theory, and profession to address the space between policy planning and lived experiences. Using the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and its electronic health record based Meaningful Use Incentive Program as context, two studies were conducted to explore how professionals react to and within institutional arrangements, drawing on the microfoundations of institutional theory and the discourse of professionalism. More specifically, the first study considers meeting transcripts of policy planning and identifies oppositional forces within the discourse of professionalism that became embedded within electronic health records, which healthcare professionals were mandated to use. As a result of these embedded tensions I argue that physicians had opportunity to create their own discourse of professionalism that pushed back against policy intentions through the addition of medical scribes, which was the focus of the second study. Combined, these studies demonstrate the importance of profession in advancing our understanding of materiality and power within institutional scholarship, and in particular working to connect macro perspectives such as policy planning and micro perspectives such as day-to-day work routines.

Graduation Semester

2022-05

Type of Resource

Thesis

Copyright and License Information

Copyright 2022 Ann Bryan

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